West Virginia PATH Program Addresses Rural Homelessness

West Virginia has many features of which to be proud. Predominantly rural, the mountain state attracts people seeking ancient forests, secluded spots, and picturesque small towns. Residents of the state harbor deep loyalty to their way of life and are seemingly there to stay: West Virginia boasts the highest homeownership rate in the country, according to the report, Housing Characteristics: 2010 at the Census Bureau (PDF | 2.3 MB). These same points of pride, however, challenge service providers in their efforts to address the seeming anomaly of homelessness throughout the state.

Homelessness in West Virginia is difficult to quantify. The Department of Housing and Urban Development’s point-in-time count tallies the number of people in a community who are experiencing homelessness on a single night. However, carrying out tallies in West Virginia is hampered by rural terrain and difficulty reaching people who are “hidden” in very isolated areas or temporarily staying in others’ homes, according to the West Virginia Interagency Council on Homelessness’ Progress and Recommendations Report for Governor Earl Ray Tomblin – 2014 (PDF | 9.5 MB).

Rural Homelessness Presents Unique Challenges

“Rural homelessness is much different than what you find in urban areas,” observes Merritt Moore, Statewide PATH Coordinator. “In a city, you may encounter someone who is homeless when you round a corner, when you get off a subway. There are more emergency shelters and more feeding stations. Rural areas have fewer resources for people experiencing homelessness and fewer communal areas where we can provide and obtain information.” Learn more about homelessness and rural residents.

To address this, Moore recently arranged technical assistance on rural outreach for supervisors, front-line staff, program managers, and fiscal personnel of PATH programs in West Virginia. This two-day event was one of many technical assistance opportunities provided by SAMHSA to strengthen PATH programs. Technical assistance in previous years focused on coordinated entry, data, and motivational interviewing. Elliott Birckhead, interim deputy commissioner for programs for West Virginia Bureau for Behavioral Health and Health Facilities, remembers, “One of the first steps we took when SAMHSA started offering technical assistance to PATH grantees – we were the first to take advantage of the offer – was to create a PATH logic model. It helped us strategically reallocate existing dollars to better provide coverage across the state.”

Following the logic model, West Virginia doubled the original number of its grantees. Yet major portions of the state, including the Eastern Panhandle, were still underserviced. In October 2013, the Bureau for Behavioral Health and Health Facilities released an Announcement of Funding Availability, which resulted in a total of seven grantees serving PATH consumers in all six regions of West Virginia.

Although only recently designated a PATH grantee, the West Virginia Coalition to End Homelessness (WVCEH) has long provided technical assistance and training to the homeless provider network. In addition to serving as the lead agency for the West Virginia Balance of State Continuum of Care, WVCEH propels implementation of the Vulnerability Index/Service Priority Decision Assistance Tool. This tool helps identify the best type of support and housing intervention for an individual from three categories of recommendation: permanent supportive housing [link to the H2 on the Poverty and Housing page under the Homelessness and Housing topic], rapid re-housing, and affordable housing.

The Homeless Management Information System (HMIS) is another tool that facilitates collaboration among the PATH grantees in West Virginia. HMIS collects intake data and data on the provision of housing and other services to people who are experiencing homelessness. SAMHSA has mandated that all PATH providers integrate their PATH data into the local HMIS by the end of the federal fiscal year 2016 (September 30, 2017), but West Virginia’s PATH providers are already doing so. HMIS reduces duplication of services, saves time, and minimizes consumer frustration by sharing data and resources.

These collaborative efforts advance the charge of the West Virginia Interagency Council on Homelessness (WVICH) to “ensure services and housing are provided in an efficient, cost-effective, and productive manner." Originally created in 2004, WVICH was re-established by Governor Tomblin in 2013 as a state agency-driven entity dedicated to homelessness planning and policy development. It includes seven subcommittees for specific populations and focus areas: chronically homeless; families; veterans; youth; aged; special populations, including people with mental and/or substance use disorders; and community.

Initial findings from more than one subcommittee highlight the importance of addressing behavioral health issues. The Chronically Homeless Subcommittee reports that persons experiencing chronic homelessness are among the most vulnerable and tend to have higher rates of behavioral health conditions. The Veterans Subcommittee suggests that untreated mental health issues, post-traumatic stress disorder (PTSD), and traumatic brain injury are major contributors to homelessness among veterans. The latter of these findings is particularly noteworthy, considering that the West Virginia Department of Veterans Assistance reports that almost one in ten West Virginians have served in the U.S. Armed Forces.

PATH Program Connects Rural Residents to Services

Moore recognizes the role behavioral health issues can play in connecting people experiencing homelessness with services. Policies at emergency shelters often exclude people deemed “difficult to serve” because of a mental and/or substance use disorder. There can be long waiting lists for treatment services for substance use disorders. The PATH program, however, has proven instrumental in overcoming these challenges.

“PATH provides many services that reduce the risk and impact of homelessness,” explains Moore. “Improving access to behavioral health services often can be the key to obtaining and maintaining permanent housing. Our providers offer outreach, screening and assessment services, referral to community mental health and alcohol or drug treatment services, case management, and other services that individuals experiencing homelessness or at imminent risk need. They helped ‘B.T.’ secure his own apartment after experiencing homelessness for more than ten years due to mental and substance use disorders. They helped ‘A.T.’ avoid eviction and now he’s on his way to helping others as a Peer Support Specialist.”

Recruiting people with lived experience has been invaluable to outreach efforts. They know where to find people who may be experiencing homelessness and how to reach them emotionally. The percent of eligible people enrolled through outreach by West Virginia PATH providers is higher than the national average, as is the percent of people receiving community mental health services. The combination of peers helping peers and providers helping providers is working. For a state receiving the minimum allocation of PATH dollars and working with the inherent challenges of a rural context, this is indeed something of which to be proud.

This article was originally published as a Grantee Spotlight to highlight the September 2015 theme of Recovery. September is Recovery Month.